Pancreas
A 13-year-old presents with recurrent abdominal pain. His current episode has lasted more than 8 hours. Lab studies show significant elevation in amylase and lipase. This is the next best step in evaluation.
Ultrasound
This finding is present in the lower esophageal sphincter in a patient with achalasia
Increased LES tone
A 6-month-old child is noted to have dolicocephaly, hypotonia, poor suck and hepatosplenomegaly. Expect this additional lab finding on further evaluation.
Increased Very Long Chain Fatty Acids (Zellweger Syndrome)
3-year-old patient is admitted with severe malnutrition. They are being given over 2,000 calories a day. These are 2 lab abnormalities you may expect to be low on day 3 of refeeding.
Low phosphate and low potassium
A 2-year-old visiting grandparents' house was seen swallowing 2 button batteries from a TV remote. He was taken to the ED immediately and clinically stable. X-ray shows a button battery in the stomach and another button battery in the esophagus. This is the next best step in management.
Immediate endoscopic removal of all button batteries.
This is most likely to cause elevation in both amylase and lipase levels
Choledocholithiasis
Epidermolysis bullosa is most likely to cause esophageal strictures in this portion of the esophagus
Proximal esophagus
A 3 day old boy presents with lethargy and poor feeding. Lab findings show an ammonia level >1,000 and normal glucose. Serum pH is 7.58 and electrolytes and serum ketones are normal. This is the MOST likely diagnosis.
Ornithine transcarbamylase (OTC) deficiency
An anorexic patient is admitted for nutrition rehabilitation with BMI of 15. He develops seizures and muscle weakness on day 3 of admission. What is likely the cause of these symptoms?
Low phosphorous
This describes how sharp foreign bodies move throughout the GI tract (blunt end leading).
Jackson’s Axiom
An umbilicated lesion is seen at the antrum on endoscopy for a patient with reflux. This is the next best step in management of this lesion.
Observation
This condition results from failure of separation of the foregut from the lung
Tracheoesophageal fistula
An 8-year-old girl develops increased ammonia and lethargy after an illness. Lab findings show increased orotic acid in urine. This determines increased risk of symptomatic disease
Random X-activation (OTC deficiency)
A child on long-term TPN develops dermatitis and thrombocytopenia with concerns for essential fatty acid deficiency. This lab test will help clarify the diagnosis.
Triene/tetraene ratio
This type of caustic ingestion is likely to cause liquefactive necrosis of the esophagus
alkaline
A 2-month-old with Down syndrome presents with persistent vomiting. There is strong concern for duodenal atresia. This anatomic anomaly is often associated.
Annular Pancreas
A newborn male presents with severe reflux and feeding difficulties. After an extensive evaluation, upper endoscopy is performed and shows circumferential narrowing in the mid esophagus with normal esophageal mucosa. This is the most likely diagnosis.
Congenital esophageal stenosis
A child presents with jaundice and hepatomegaly. Lab studies show elevated AFP (>2,000). Imaging shows hepatic mass that is found to be premalignant. This is the likely diagnosis.
Tyrosinemia Type 1
Which micronutrient is required at higher amounts/kg for adolescent girls than boys?
Iron
This type of caustic ingestion is likely to cause coagulation necrosis of the stomach
Acidic
10-year-old patient presents with their 3rd episode of pancreatitis. Family history reveals several relatives with pancreatic cancer. This mutation is of greatest concern as the cause of recurrent pancreatitis.
PRSS1 mutation
A 22 month old F is referred for spits ups and emesis after introduction of table foods at 18 months of age. Emesis is NBNB and contains food particles. Occasional gagging before emesis. No improvement on PPI. Worsening dysphagia with solids and slower weight gain over the last 2 months. Upper GI study shows an indentation on the posterior esophagus in the upper third portion. This is the next best step in diagnosis.
Chest MRI
Aldolase B (hereditary fructose intolerance)
A 5 year old with intractable seizures is started on a ketogenic diet. In counseling family about complications of this diet, in addition to constipation you mention the following.
Decreased height velocity
A 3-year-old presents to the ED after swallowing a penny 3 hours ago. Patient ate chicken nuggets after the ingestion. No emesis or abdominal pain and asking for a popsicle. KUB shows 18mm metallic round object in the stomach. This is the best next step in management.
Discharge from the ED